Informed Consent & Consent to Treatment, Financial and Ethics Policy:
The initial brief telephone consultation is free (typically 15 minutes). This consult may include information about services, a brief intake of symptoms, preliminary diagnosis, potential treatment, and a rough-non-binding estimate of possible costs. Initial phone visits longer than 15 minutes may be considered as a phone visit, and agreement for payment will be negotiated to mutual satisfaction.
Office visits fees are $75.00/hr. The fee is calculated based on the actual amount of time in the office while engaging with the physician in any way that occupies his time. This includes: consultation time, order preparation time, procedure time, lab order time, accounting, and insurance form preparation time. Typical office visits for both new and returning patients, for medical or counseling appointments lasts 1.5 hours, but this is variable, and the actual time (more or less) will dictate the fee charged at each visit.
Telephone consultations (after free initial phone visit) that involve more than re-orders or simple clarifications of instructions, or that last longer than five minutes, are charged at a per minute rate based on the office visit rates. The line between a short question or clarification, and a conversation that involves diagnosis and prescription is sometimes blurry. I attempt to reduce the need for lengthy office visits by being available for shorter phone visits for follow up. Thus, small phone visit charges (based on time spent) may apply for these shorter diagnosis and treatment interventions. I wish to strongly encourage phone or email reordering of supplements, and taking the high quality supplements I attempt to provide. You are welcome to simply call to reorder and ask for products to be mailed or picked up. But, if in the process of these follow up questions, we uncover new symptoms, reactions, etc. please realize that such conversations fall into the realm of an office visit. It is important to me to stay in contact with patients to monitor their progress, resolution of old symptoms, new symptoms, or side effects. Some patients are very cost sensitive, so please recognize that it is easy to spend a great deal of time talking on the phone, but, that this is a business, I am a professional, and that time and knowledge is the primary commodity that I have to offer.
Procedures such as LSA (Limbic System Analysis), specimen collection, Body Composition Analysis, Physical exam, brainwave analysis and neurofeedback training, LENS (Low Energy Neurofeedback System), GDV (Gas Discharge Visualization), phlebotomy, ear irrigation, computer blood analysis, Heidelberg stomach acid testing, Foot spa, cryosurgical skin lesion removal, etc. may incur additional fees in addition to office visit time.
Pharmacy orders and refills (from pharmacies such as Costco, Fred Meyers, Walgreens, etc.) and refills called in for a prescription may be billed at $5-$15/order.
Orders for refills of nutritional supplements from my office pharmacy will not incur additional charges over the cost of products, plus the normal preparation time in mixing custom herbal formulas, and shipping and handling, unless the prescription of these supplements has entailed a phone visit as elaborated above.
Laboratory Reports received from Lab will be faxed, emailed, mailed, and/or retained for review until office visit. For the service of laboratory review, interpretation, shipment, and recommendation, a minimum charge of $10 will be assessed. Additional charges may apply for more complex laboratory interpretation.
Payments for products and services are expected at the time of service unless arrangements are made for a payment schedule. Cash, check, and credit card are acceptable forms of payment. Accounts which have unpaid balances may require payment in full before additional services or products are rendered. Contracts for payment rate may be negotiated.
Insurance companies are not billed from this office. Payment for office visits is expected by the patient at the time of service. We will provide the relevant insurance codes on your invoice for you to submit to your insurance company for reimbursement. Note: supplements are almost never reimbursed by insurance companies.
Personal checks that are returned for insufficient funds, will incur an additional $20.00 charge to your bill. The bank charges $15 for each returned check, and $5 is assessed for the very significant effort of resubmitting the check, phone calls and mail, etc. that is required to insure that the funds are now adequate.
Unopened supplements may be returned for full refund within one month of purchase. Opened supplements or those purchased over one month previously can be returned for a refund of half the original purchase price. No refund will be given for supplements returned over 3 months after the purchase date. If more than 5 bottles of supplements are returned at a time, an additional restocking and accounting fee of $2.00 per bottle will be deducted from the refund. Special order supplements (those we don’t usually stock) require a non-refundable half price down payment at the time the order is made.
Some supplements purchased in quantities of 3 or greater, may be purchased at a 10% discount. Some supplements have a smaller markup and these items are not available for the volume discount. Refund on opened products is limited to the margin over cost only.
Records will be released to other practitioners upon the receipt of a properly signed records release form.
This office attempts to comply with the HIPPA requirements for privacy. But, perfect anonymity is impossible, especially in a home office, family-environment practice. Thus, if you have a need for absolute anonymity, this will not be possible to provide in this setting. Thus, be prepared for normal confidentiality regarding issues and records. This office strives to produce a family-environment where patients meet each other and may know each other’s names. Thus, no extraordinary precautions will be made to protect identities. Supplements may be left in the large black mailbox with the invoice for after-hours pickup, and thus your identity may potentially be seen by others. Again, if extreme confidentiality/anonymity is required, then it may be best to see another practitioner.
This office is openly Christian in its profession of faith and guiding principles in practice and relationship. No effort will be made to conceal our faith as this approach to life has deeply permeated all aspects of our business. As such, counseling may include references to Biblical principles and philosophies. A Christian worldview will never be imposed upon a patient, but in the process of counseling or medical intervention, the patient may be asked to consider the principles of Christianity as part of the therapeutic process. Patients of all faiths are welcome, but if being exposed to Christian principles, symbols, and/or discussion/consideration of such is offensive, then it may be best to find another practitioner that more closely embraces a worldview more similar to your own.
The outcome of therapy cannot be promised or predicted with certainty; such is the nature of the “practice” of medicine. Every effort is made to offer diagnosis and treatment recommendations consistent with research, reasonable theory and/or experience. The opinions regarding how to live life on a mental, emotional, spiritual and physical level, and the cause(s) of a particular disease condition, are offered with sincerity, but may be inaccurate and produce unintended consequences. As such, the patient contracts with the doctor as a partner in the process of healing, recognizing that there are risks which are unavoidable. The patient owns his body, soul (mind and emotions), and spirit (that point of consciousness given to us by God), and has primary responsibility for survival and healing each of these facets of life, and informing the doctor of all symptoms that may be relevant. As such, the doctor functions as a teacher, diagnostician, counselor, and coach and strives to assist the patient in attaining the highest quality of life available.
The patient is responsible for giving truthful and complete disclosure of information about his condition, and to request redirection of effort and attention to topics more attuned to his primary concerns if he feels that his needs are not being addressed properly. This practice is oriented toward finding the cause of a condition, and as such if it is determined that the focus or cause of disease, discomfort, and/or concern is on the mental, emotional, spiritual level, then the direction of therapy may go toward a counseling intervention when the patient has come in for the symptoms of a medical condition. Every effort will be made to obtain agreement, and to be sensitive to small gestures indicative of discomfort on any level. Nevertheless, it is the patient’s responsibility to bring to overt, verbal attention, any procedure, touch, or topic, that is uncomfortable or seems irrelevant in any way.
Inherent to the process of medical intervention is the deep exploration of the complexities of life forces. As such, no topic is considered off limits unless the patient makes an explicit statement that such is the case. Therefore, topics of religion, politics, sexuality, past history, relationships, fears, employment, education, habits, entertainment, past diseases, personal history, and all body, mental, and emotional symptoms etc. may be explored in an effort to find the focal point that has generated the symptoms and discomfort for which help is being sought.
Appropriate touch is required and expected for some procedures and exams. The patient should inform the doctor immediately of any unwelcome or unpleasant touch or any sensitivities.
We recognize that naturopathic medicine and Christian counseling are optional expenditures that in general come out of your personal budget. Thus, we wish to honor you as a person who has valued us enough to compensate us for our service. We wish to meet your needs and provide you with a completely satisfying experience.
We appreciate your referrals, as the primary source of our business comes from satisfied customers. If you are happy with us, please tell someone else. If you are unhappy with anyone in this office, please tell us and we will make every possible effort to provide satisfaction.
As a patient I hereby acknowledge that I understand the concepts presented in this document and consent to treatment at the office of the above named physician(s) and, accept these conditions. I realize this it is my responsibility to inform the physicians of any predisposing factors which may make a therapy inappropriate to my particular circumstances.
Dietary supplements are in general considered safe for the vast majority of the population. Biochemical individuality of patients may render a small portion of the public vulnerable to reactions to supplements in the form of sensitivities or allergic reactions. If you suspect you are having a negative reaction to a dietary supplement, please stop taking it and immediately call the physician(s) who prescribed it, to discuss your reaction before continuing to take the supplement.
Pharmaceutical substances prescribed by Naturopathic Physicians are found on the Formulary of Naturopathic Physicians. Most of these prescription items are commonly utilized throughout the medical profession and are deemed safe under most appropriately prescribed circumstances. If you know that you are sensitive or allergic to any drugs, please inform the doctor(s) of your particular allergies at the time that you are discussing prescriptive services with this office. If you have a negative reaction to any drug, please stop taking it and immediately call the prescribing physician(s) for advice before continuing to take the drug.
Physical medicine and physical therapy techniques are in general considered safe for the majority of the population. If you have had a Cerebral Vascular Accident (a stroke) within a month prior to seeking this therapy, please inform your physician of this fact. At any time during a treatment, please inform the doctor if you feel that any technique is inappropriate to your circumstances, and the reasons why.
The Psychological and Spiritual Counseling offered in this office is generally considered to be beneficial to most patients who seek these services. If for any reason, a patient is uncomfortable with any discussion, please inform your physician if you do not want to pursue a particular course of discussion in the course of your treatment.
If a patient believes that the services offered by the above named physician(s) are not a good match to their needs, the patient should request a referral to another healthcare professional in the field of their interest who can better take their individual needs into consideration. The physician(s) will do their best to provide the most appropriate referrals available.
If at any time you require medical advice for symptoms that concern or alarm you, and we are unavailable for consultation (i.e. if we cannot or do not return your call or page within ten minutes), please proceed immediately to the nearest urgent care facility and seek professional advice there.
I, the undersigned, understand this information and agree to be treated by the above named physician. As a patient I am willing and expect to engage as an active partner in my healing. I understand the risks of treatment, acknowledge the responsibility for timely payment in exchange for goods and services, and understand the limitations of naturopathic and psychological medicine. I expect to be treated in the manner as elaborated above, and will notify the doctor of any error or omission at my earliest convenience. As such, I agree to the conditions and considerations and spirit of this policy.
Name: _________________________ Signature: ________________________ Date:__________